Correspondence (The Lancet 343, 1293-4, May 21,1994)

Home Testing for HIV

Ian Campbell, Chris Castle, Hilary Curtis, Sue Lucas, Maura O'Donahue, John Townsend,

for the HIV Testing Working Party, UK NGO AIDS Consortium, Fenner Brockway House, London SE1 OES, UK

Sir -- Frerichs' proposal for home HIV tearing kits as an HIV prevention strategy has little relevance to the experience of development organizations that are concerned about AIDS in Thailand and elsewhere.

There is little evidence that HIV testing alone prevents infection. Some studies have shown that testing together with counseling and continuing support for infected individuals (including access to condoms) has led to behavior change,[1, 2] but this tells us nothing about the effects of testing in isolation. Pretest counseling of people who test negative may be valuable in promoting behavior change, although some studies show substantial continuing risk behavior after counseling and testing.[3, 4]

More importantly, unregulated home testing Is liable to be misapplied. It is unrealistic to expect everyone to follow advice to seek confirmatory resting of initially positive results, but a substantial proportion will be false positives.  Without quality control supervision, inaccurate results may also arise from incorrect use of the saliva collection device and sample labeling errors.

The AIDS Information Centre in Kampala, Uganda, which provides voluntary testing with counseling and support, takes care to ensure that both members of couples consent separately to testing and to mutual disclosure of their results, which are kept confidential from third parties.[5] Home testing provides no such safeguards to prevent women being pressurized into testing, and publicly disgraced after a positive result.

Testing is costly. Donated blood screening is incomplete in several countries because of difficulties in maintaining supplies. If home sampling is promoted, what will happen if a laboratory unexpectedly stops testing these saliva specimens, because test kits have run out or been diverted for blood screening?

Frerichs' assertion that there are few alternatives other than premarital screening and monogamy is simplistic. Voluntary screening requires widespread understanding of its use, plus assurances of support and protection from discrimination for those found positive, and so cannot be achieved without voluntary development and education. But as education raises awareness people will choose their own prevention strategies. Some will find the use of condoms with non-regular partners, and encouraging regular partners to do likewise, a more achievable option than relying on monogamy after testing.

We believe that there is a place for well-managed voluntary HIV testing with counseling within a wider community development approach to increase understanding about HIV, to promote safer behavior, and to care for those affected.  We do not support promotion of home sampling or home testing as a prevention strategy.

1. Allan S, Tice J. Van de Perre P, et al. Effect of serotesting with counseling on condom use and serconversion among HIV discordant couples in Africa. BMJ 1992. 304: 1605-09.

2. Higgins DL, Galavotti C. O'Reilly KR, et al. Evidence for the effects of HIV antibody testing and counseling on subsequent sexual behavior. JAMA 1991; 266: 2419-29.

3. Landia SE, Earp JL, Koch GG. Impact of HIV testing and counseling on subsequent sexual behavior. AIDS Educ Prev 1992; 4: 61-70.

4. Zenilman JM, Erickson B. Fox R., Reichart CA, Hook EW. Effect of HIV posttest counseling on STD incidence. JAMA 1992; 267: 843-45.

5. Rwekikomo F. Voluntary testing centers: the AIDS Information Center experience in Uganda. In: UK NGO AIDS Consortium. Issues of HIV testing in developing countries. Report of the seminar Nov 5, 1992. London: UK NGO AIDS Consortium, 1993.